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CBT for Adolescents With Anxiety: Mature Yet Still Developing
Open accessAbstract
Anxiety disorders are common in adolescents (ages 12 to 18) and contribute to a range of impairments. There has been speculation that adolescents with anxiety are at risk for being treatment nonresponders. In this review, the authors examine the efficacy of cognitive-behavioral therapy (CBT) for adolescents with anxiety. Outcomes from mixed child and adolescent samples and from adolescent-only samples indicate that approximately two-thirds of youths respond favorably to CBT. CBT produces moderate to large effects and shows superiority over control/comparison conditions. The literature does not support differential outcomes by age: adolescents do not consistently manifest poorer outcomes relative to children. Although extinction paradigms find prolonged fear extinction in adolescent samples, basic research does not fully align with the processes and goals of real-life exposure. Furthermore, CBT is flexible and allows for tailored application in adolescents, and it may be delivered in alternative formats (i.e., brief, computer/Internet, school-based, and transdiagnostic CBT).
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“Although abundant evidence supports the efficacy of cognitive behavioral therapy (CBT) in treating adolescent anxiety, not all teens respond positively to CBT.”
From Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety (2023) · cites this paper as [17]
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“The certainty of the evidence for efficacy outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework across the following 5 domains: study limitations, imprecision, heterogeneity and inconsistency, indirectness, and publication bias.”
From Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents: A Network Meta-analysis (2019) · cites this paper as [29]
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Self-citationD‐cycloserine‐augmented one‐session treatment of specific phobias in children and adolescents
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Stiede, J. T., Trent, E. S., Viana, A. G., Guzick, A. G., Storch, E. A., & Hershfield, J. (2023) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2022.12.001 · Cited by 25
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“While CBT is the current gold-standard intervention for pediatric anxiety (3, 22), response rates are variable (68), leaving a large portion of treated youths with significant symptoms following treatment (56).”
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“Treatment as usual: CBT All participants received classic CBT, a commonly used evidencebased therapy for anxiety and depression among adolescents (Buitelaar et al., 2009; Kendall and Peterman, 2015; Klein et al., 2007).”
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“…a challenging and resistant group (particularly in the context of ‘ traditional ’ therapy) and have outlined that approaching interventions of this nature in a more engaging manner may assist in fostering more positive outcomes (Kendall & Peterman, 2015; Sommers-Flanagan & Sommers-Flanagan, 2006).”
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“First, meta-analytic studies on childhood anxiety reveal that the majority of research that had examined the efficacy of CBT had used combined child and adolescent samples, and far fewer studies were conducted on adolescents alone (Kendall & Peterman, 2015; Reynolds et al., 2012).”
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“The first-line psychological treatment for youth anxiety disorders is CBT (Kendall and Peterman, 2015).”
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“Yet, CBT is effective for diverse age groups (Cuijpers et al., 2020; Kendall & Peterman, 2015), and the teens and young participants in this study, often referred to as Digital Natives (Prensky, 2005), had a similar level of familiarity with computers and mobiles phones across the age range.”
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“Although response rates for exposurebased cognitive behavioral therapy are similar across childhood, adolescence, and adulthood (Kendall & Peterman, 2015), the factors contributing to insufficient response rates, and thus optimal approaches to enhance treatment efficacy, maymeaningfully differ…”
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“…as CBT has a strong evidence base for being effective in working with adolescents in clinical samples to reduce symptoms of depression and anxiety (Kendall & Peterman, 2015; Webb et al., 2012), and in non-clinical samples to reduce the negative effects of problematic traits such as perfectionism…”
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“After intervention with exposure or cognitive restructuring, 69 and 78%, respectively, of the children scoring in the clinical range of social anxiety at Pretest 1 returned to “normal” levels of anxiety at Follow-up; this is in line with previous studies (Kendall & Peterman, 2015).”
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“[6,10] Distressed teens are at higher risk for anxiety disorders,[6] depression,[11] behavioral problems, and suicide.”
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“CBT programs have been proven effective for about 60–70% of children receiving them (Kendall & Peterman, 2015), raising a question of whether individual tailoring could optimize the effect of treatment.”
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“A focus on human adults (18 years of age or older) was preferred to minimise the bias potentially caused by paediatric populations in the data set; they may have different treatment experiences and outcomes linked to CBT use [19].”
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“…in young people, exposure is graded and delivered both in session and out of session, and usually preceded by the introduction of coping strategies (Kendall & Peterman, 2015) despite recent evidence that these might not enhance outcomes, and may in fact impede positive treatment outcomes…”
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“In this regard, one study showed that adolescents who had a high intake of fast food were more than three times more likely to report anxiety-induced sleep disturbance (Khan et al., 2017).”
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“Interventions focusing on increasing awareness of anxiety signs, enhancing problem-solving skills, and self-evaluation and rewards have also been suggested to be effective approaches for reducing test anxiety among children and adolescents (Kendall & Peterman, 2015; Yeo et al., 2016).”
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“Adolescents’ stress may be caused by an array of factors, such as dramatic social and emotional changes (Kendall & Peterman, 2015), school performance, and increased responsibility (Hussain et al., 2008).”
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“…numerous Randomized Controlled Trials (RCTs) corroborating its efficacy for both adults and adolescents (Heimberg, 2002; Jørstad-Stein and Heimberg, 2009; Kendall and Peterman, 2015; Ponniah and Hollon, 2008; Salzer et al., 2018), even when delivered in a brief format (Thorisdottir et al., 2018).”
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“CBT typically involves elements such as cognitive restructuring and exposure to fear-evoking stimuli (e.g., social situations [56]).”
Effects of Problem Solving Therapy in Substance Use Disorder in Adolescents
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Want to help your patients with food allergy anxiety? Do proximity challenges!
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Mediators of youth anxiety outcomes 3 to 12 years after treatment
Makover, H. B., Kendall, P. C., Olino, T. M., Carper, M. M., Albano, A. M., Piacentini, J. C., Peris, T. S., Langley, A. K., González, A., Ginsburg, G. S., et al. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102188 · Cited by 4
Self-citationBest practices in supervising cognitive behavioral therapy with youth
Friedberg, R. D. (2018) · World Journal of Clinical Pediatrics · doi:10.5409/wjcp.v7.i1.1 · Cited by 4
Silfvernagel, K. (2017) · Linköping studies in behavioural science · doi:10.3384/diss.diva-135823 · Cited by 3
“In light of the developmental challenges and increased vulnerability to anxiety during adolescence, some have speculated that adolescents may be less responsive to CBT than adults (Kendall & Peterman, 2015).”
BackgroundInfluentialA homeschool‐based cognitive behavioral program to improve adolescent mental health
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Kasson, E. M., Vázquez, M. M., Li, X., Doroshenko, C., Szlyk, H. S., Montayne, A., Fitzsimmons‐Craft, E. E., Wilfley, D. E., Taylor, C. B., & Cavazos‐Rehg, P. A. (2024) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-024-00444-4 · Cited by 3
“Similarly, patterns of avoidant coping mechanisms often present among teens with anxiety may contribute to fears and reluctance with treatment uptake, as well as additional difficulties with remaining in treatment (Kendall & Peterman, 2015).”
Roach, A., Stokes, I., McDonnell, K., Griffiths, H. R., Curry, V., Heyman, I., Balakrishnan, S., Ndoci, X., Bennett, S. D., & Shafran, R. (2024) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465824000390 · Cited by 3
“…was found to be empirically tested with adolescents despite adolescent anxiety being one of the most common referrals to child and adolescent mental health services (Gibbons et al ., 2021; Hansen et al ., 2021) and evidence that adolescents respond favourably to CBT (Kendall and Peterman, 2015).”
Emmelkamp, J., Wisman, M. A., Beuk, N., Stikkelbroek, Y. A. J., Nauta, M. H., Dekker, J., & Christ, C. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04291-6 · Cited by 6
“Treatment as usual: CBT Both groups will receive CBT, a commonly used evidence-based therapy for adolescents with anxiety [61] and depression [62, 63].”
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Psychological treatment of adolescents.
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“changes in the biological, cognitive, emotional and social functioning of the organism [14].”
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“However, research is clear that a sizeable proportion of children and families do not achieve diagnostic remission following CBT intervention (Ginsburg et al., 2011; Kendall and Peterman, 2015) and that relapse rates of over 50% have been reported at 6-year follow-up (Ginsburg et al., 2014).”
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“In their review, Kendall and Peterman (2015) highlight that following CBT treatment up to 80% of youth, both children and adolescents with anxiety and depressive disorders, show improvement in clinical symptoms and up to 70% do not meet criteria for an anxiety disorder.”
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Rabner, J. C., Maxwell, C. A., Pinney, E. L., & Kendall, P. C. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00053-4 · Cited by 1
Self-citationCognitive Behaviour Therapy for Adolescents
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Depression, Anxiety, and Other Internalizing Disorders
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Berg, M. (2021) · Linköping studies in behavioural science · doi:10.3384/diss.diva-173553
“Some studies have included age spans between, for instance, 12-18 years (Kendall & Peterman, 2015) or up to 25 years (Ebert et al., 2015).”
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Bibliography: Anxiety Across the Lifespan
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Metadata
- Authors
- Kendall, P. C., & Peterman, J. S.
- Affiliations
- Temple University (US)
- ORCID
- Kendall, Philip C.
- Venue
- American Journal of Psychiatry
- Published
- 2015-06-01
- Volume
- 172
- Issue
- 6
- Pages
- 519-530
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W1908297199
- Cited by
- 115
- References
- 145
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 9 · 2023: 10 · 2022: 24 · 2021: 13 · 2020: 12 · 2019: 6 · 2018: 12 · 2017: 13 · 2016: 6
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, adolescent anxiety, anxiety disorders, treatment response, treatment non-responders, fear extinction, exposure therapy, treatment efficacy
- MeSH terms
- Adolescent, Age Factors, Anxiety Disorders, Child, Extinction, Psychological, Fear, Female, Humans, Male, Personality Development, Cognitive Behavioral Therapy, Treatment Outcome
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